Giant Dedifferentiated Melanoma Mimicking Soft Tissue Sarcoma with Loss of Conventional Melanocytic Markers: Diagnostic Utility of PRAME and BRAF V600E Immunohistochemistry

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ID: 314200
2026
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Abstract
Dedifferentiated melanoma can lose conventional melanocytic markers and mimic soft tissue sarcoma, complicating diagnosis. In some cases, next-generation sequencing (NGS) has been required to secure the diagnosis. We report a giant (>10 cm) sarcomatoid melanoma in which diffuse PRAME immunohistochemistry raised suspicion and concordant BRAF V600E positivity in both the sarcomatoid tumor and an associated nevus established the diagnosis of melanoma. This two-step, widely accessible workflow, PRAME screening followed by targeted BRAF V600E testing, enabled diagnosis without comprehensive NGS and may aid similarly challenging sarcomatoid cutaneous tumors.
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Authors Moe Usui, Yasuaki Ikuno, Shingo Hirano, Yoshimichi Kobayashi, Takahiro Koike, Yasuhiro Maeda, Akihiko Yamaguchi, Toshifumi Takahashi, Akiko Arakawa, Mai Noujima, Noriki Fujimoto
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Journal clinical and experimental dermatology
Year 2026
DOI
10.1093/ced/llag217
URL
https://doi.org/10.1093/ced/llag217
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